Ileana Peride

Value of ultrasound elastography in the diagnosis of native kidney fibrosis.

In the last decade, ultrasound elastography, an already widely used technique in the diagnosis of hepatic fibrosis, has raised the attention of nephrologists as a potential valuable noninvasive tool for the diagnosis of renal fibrosis. Due to renal deep location and anatomic complexity, the shear wave techniques are the most appropriate elastography methods for exploring native kidneys. Recent research offers promising results, but further larger studies are required for a better standardization of this method and also for establishing reference values of normal kidney elasticity. This article reviews the studies conducted for exploring the native kidney, highlighting the advantages and limitations of ultrasound elastography for assessing fibrosis development in chronic kidney diseases.

New molecular insights in diabetic nephropathy.

Diabetes mellitus represents one of the major causes of functional kidney impairment. The review highlights the most significant steps made over the last decades in understanding the molecular basis of diabetic nephropathy (DN), which may provide reliable biomarkers for early diagnosis and prognosis, along with new molecular targets for personalized medicine. There is an increased interest in developing new therapeutic strategies to slow DN progression for improving patients’ quality of life and reducing all-cause morbidity and disease-associated mortality. It is highly important to have a science-based medical attitude when facing diabetic patients with associated comorbidities and risk of rapid evolution toward end-stage renal disease. The data discussed herein were mainly from MEDLINE and PubMed articles published in English from 1990 to 2015 and from up-to-date. The search term was “diabetic nephropathy and oxidative stress”.

Supersonic Shear Wave Ultrasonography for Assessing Tissue Stiffness in Native Kidney

Recent years have brought shear wave elastography to the attention of nephrologists as a non-invasive method for detecting kidney fibrosis and, therefore, as a potential tool for reducing the need for kidney biopsy. Few studies are performed on native kidney. We aimed to compare cortical stiffness, assessed by measuring Youngs modulus (YM, kPa) with SuperSonic Imaging technology, in patients with various degrees of chronic kidney disease (CKD) compared with healthy individuals. Cortical stiffness was measured by two operators, in different sessions, in 32 patients with CKD stages 3-5 and 20 healthy individuals. Comparison between mean YM values in CKD and those in controls and also between the different stages of CKD was our primary objective. The influence of other possible confounders on YM readings was also investigated and analyzed. Mean YM was significantly greater in CKD patients than in controls. Estimated YM was not able to differentiate the stages of CKD, except stage 5. Intra-subject variability was greater in CKD than in controls. Body mass index was the most important confounder in multiple analyses, in both the CKD and control groups. Our results highlight a positive correlation between increased cortical stiffness and presence of CKD. Further studies are needed to validate this method for implementation in daily clinical practice.

Preoperative status of diabetic and non-diabetic chronic dialyzed patients – therapy implications

Abstract Background and Aims: The evaluation of preoperative status of diabetic chronic dialyzed patients consists in determining the preoperative risk factors and choosing the optimal surgery time to reduce further complications. Material and method: we conducted a retrospective study that included 156 chronic dialyzed subjects (diabetic and non-diabetic patients) undergoing surgical interventions, between 2010 and 2013. The incidence of preoperative parameters considered as risk factors (e.g.: cardiovascular, cerebrovascular or pulmonary diseases, anemia, nutritional and inflammatory status) was compared between the 2 groups of patients. Results: the diabetic group compared to the non-diabetic one presented a statistically significant higher value of the following variables: obesity (29.8% vs. 8%, p<0.05), ischemic cardiovascular disease (100% vs. 85.8%, p<0.05), congestive heart failure (100% vs. 79.7%, p<0.05), peripheral vascular disease (42.1% vs. 7%, p<0.05), stroke sequelae (12.28% vs. 3.03%) and elevated Creactive protein levels (4.01±5.4 vs. 6.34±10.28, p<0.05). There were no statistically significant differences between the 2 groups regarding: age, smoking status, hypertension, mean hemoglobin, serum albumin, and chronic lung diseases prevalence (p>0.05). Conclusions: considering the high prevalence of cardiovascular diseases in diabetic patients, the preoperative evaluation of dialyzed diabetic individuals should be performed thoroughly, emphasizing the diagnosis and staging of cardiovascular diseases, chronic lung diseases and nutritional status.